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Background: Cladribine shows efficacy in multiple sclerosis (MS), but Latin American (LATAM) real-world data is limited, despite potential sociodemographic variations. Objective: Investigate baseline characteristics and clinical response in highly active MS patients in Mexico, identifying predictors of early treatment response. Method: A multicenter cohort study analyzed retrospective data from individuals with "highly active" MS in the Cladribine Patient Support Program across 11 Mexican clinics. Criteria included one-year prior treatment with another disease-modifying treatment and recent relapse with specific MRI findings. Primary outcomes focused on achieving NEDA-3 status after 12 months. Results: In the follow-up, 67.5% maintained NEDA-3 status. Baseline EDSS scores decreased significantly from 1.50 to 1.00 (p = 0.011), with no confirmed disability worsening. No significant differences were observed between NEDA-3 achievers and non-achievers in demographic and clinical variables. No severe adverse events were reported. Conclusion: Cladribine showed early and effective control of active MS in Mexican patients, demonstrating a secure profile with minimal adverse events. This study provides valuable real-world evidence in the LATAM context.

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Introducción: Se ha reportado la utilidad de la procalcitonina para predecir bacteriemia en pacientes oncológicos con fiebre, pero existen pocos datos sobre la utilidad de la interleucina 6. Este estudio tuvo como objetivo establecer la especificidad y sensibilidad de la procalcitonina y la interleucina en pacientes oncológicos con bacteriemia y sangre positiva. cultura. Métodos : Este estudio transversal, de fuente prospectiva, se realizó en el Hospital de SOLCA, Guayaquil. El período de estudio fue de enero a diciembre de 2015. Se incluyeron pacientes mayores de edad y menores de 65 años con diagnóstico de enfermedad oncológica con diagnóstico de SIRS, sepsis o shock séptico. Las variables fueron presencia de bacteriemia, procalcitonina (PCT), interleucina-6 (IL-6), edad, sexo y reporte de hemocultivo. La muestra fue no probabilística . Se utilizó estadística descriptiva e inferencial. Se analizaron dos grupos: la presencia y ausencia de bacteriemia, y en cada grupo se realizó una prueba diagnóstica de procalcitonina e interleucina-6. Resultados : Participaron un total de 169 pacientes, 69 con hemocultivos positivos (G1) y 100 controles sin bacteriemia (G2). La procalcitonina fue de 14,6 en G1 frente a 0,54 ng/ml en G2 ( P = 0,0001). IL-6 fue de 1479,47 ng/ml en G1 frente a 4,37 ng/ml en G2 ( P < 0,001). La sensibilidad (S) de la PCT fue del 81,2 %, la especificidad (E) del 79 % y el área bajo la curva de 0,862. P<0.0001. La S de IL-6 fue 98,6%, la E fue 95% y el área bajo la curva fue 0,996 P<0,0001. Conclusión: La interleucina-6 es una buena prueba como predictor de bacteriemia en pacientes oncológicos por su alto valor de especificidad y para establecer que si se tiene bacteriemia es por su alta especificidad.

Introduction: The utility of procalcitonin to predict bacteremia in cancer patients with fever has been reported, but few data exist on the utility of interleukin 6. This study aimed to establish the specificity and sensitivity of procalcitonin and interleukin in cancer patients with bacteremia and positive blood culture. Methods: This cross-sectional study, from a prospective source, was carried out at the Hospital de SOLCA, Guayaquil. The study period was from January to December 2015. Patients of legal age and under 65 years of age with a diagnosis of oncological disease with a diagnosis of SIRS, sepsis, or septic shock were included. The variables were the presence of bacteremia, procalcitonin (PCT), interleukin-6 (IL-6), age, sex, and blood culture report. The sample was nonprobabilistic. Descriptive and inferential statistics were used. Two groups were analyzed: the presence and absence of bacteremia, and a diagnostic test for procalcitonin and interleukin-6 was performed in each group. Results: A total of 169 patients participated, 69 with positive blood cultures (G1) and 100 controls without bacteremia (G2). Procalcitonin was 14.6 in G1 vs 0.54 ng/ml in G2 (P =0.0001). IL-6 was 1479.47 ng/ml in G1 vs 4.37 ng/ml in G2 (P < 0.001). The sensitivity (S) of PCT was 81.2%, the specificity (E) was 79%, and the area under the curve was 0.862. P<0.0001. The S of IL-6 was 98.6%, the E was 95%, and the area under the curve was 0.996 P<0.0001. Conclusion: Interleukin-6 is a good test as a predictor of bacteremia in cancer patients due to its high specificity value and to establish that if you have bacteremia, it is due to its high specificity.

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ABSTRACT Background: Multiparametric magnetic resonance imaging improves the performance of prostate cancer (PCa) diagnostics through a better selection of patients. Objectives: The aim of the study was to study the detection rate (DR) of systematic and targeted cognitive biopsies in a cohort with the previous negative systematic biopsies. A secondary objective was to describe the value of prostate-specific antigen density (PSAd) in the detection of clinically significant PCa (CSPCa). Methods: We designed a prospective, single-center, and comparative study to determine the DR of systematic and targeted cognitive biopsies. The clinical and pathological characteristics of each patient were described. Results: A total of 111 patients with Prostate Imaging Reporting and Data System lesions > 3 were included in the study. PCa was detected in 41.4% (46 of 111 patients); 42 (91.3%) were detected by systematic biopsy and 30 (65.2%) by targeted biopsy. CSPCa was detected in 26 (23.4%), 23 (88.5%) by systematic biopsy, and 21 (76.9%) by targeted biopsy. PSAd > 0.15 was directly associated with CSPCa. Conclusion: The detection of PCa by systematic biopsy in this series was higher than 80%; hence, its routine use should not be replaced by targeted biopsy, since it continues to be the cornerstone of the diagnosis in patients with prior negative biopsies.

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Background: Multiparametric magnetic resonance imaging improves the performance of prostate cancer (PCa) diagnostics through a better selection of patients. Objectives: The aim of the study was to study the detection rate (DR) of systematic and targeted cognitive biopsies in a cohort with the previous negative systematic biopsies. A secondary objective was to describe the value of prostate-specific antigen density (PSAd) in the detection of clinically significant PCa (CSPCa). Methods: We designed a prospective, single-center, and comparative study to determine the DR of systematic and targeted cognitive biopsies. The clinical and pathological characteristics of each patient were described. Results: A total of 111 patients with Prostate Imaging Reporting and Data System lesions > 3 were included in the study. PCa was detected in 41.4% (46 of 111 patients); 42 (91.3%) were detected by systematic biopsy and 30 (65.2%) by targeted biopsy. CSPCa was detected in 26 (23.4%), 23 (88.5%) by systematic biopsy, and 21 (76.9%) by targeted biopsy. PSAd > 0.15 was directly associated with CSPCa. Conclusion: The detection of PCa by systematic biopsy in this series was higher than 80%; hence, its routine use should not be replaced by targeted biopsy, since it continues to be the cornerstone of the diagnosis in patients with prior negative biopsies.

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We analyzed the neurological manifestations in Mexican patients hospitalized with pneumonia due to COVID-19 and investigated the association between demographic, clinical, and biochemical variables and outcomes, including death. A retrospective, analytical study was conducted using the electronic records of patients hospitalized between 1 April 2020 and 30 September 2020. Records of 1040 patients were analyzed: 31.25% died and 79.42% had neurological symptoms, including headache (80.62%), anosmia (32.20%), ageusia (31.96%), myopathy (28.08%), disorientation (14.89%), encephalopathy (12.22%), neuropathy (5.4%), stroke (1.3%), seizures (1.3%), cerebral hemorrhage (1.08%), encephalitis (0.84%), central venous thrombosis (0.36%), and subarachnoid hemorrhage (0.24%). Patients also had comorbidities, such as hypertension (42.30%), diabetes mellitus (38.74%), obesity (61.34%), chronic obstructive pulmonary disease (3.17%), and asthma (2.01%). Factors associated with neurological symptoms were dyspnea, chronic obstructive pulmonary disease, advanced respiratory support, prolonged hospitalization, and worsening fibrinogen levels. Factors associated with death were older age, advanced respiratory support, amine management, chronic obstructive pulmonary disease, intensive care unit management, dyspnea, disorientation, encephalopathy, hypertension, neuropathy, diabetes, male sex, three or more neurological symptoms, and obesity grade 3. In this study we designed a profile to help predict patients at higher risk of developing neurological complications and death following COVID-19 infection.

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Fibrosing diseases are causes of morbidity and mortality around the world, and they are characterized by excessive extracellular matrix (ECM) accumulation. The bHLH transcription factor scleraxis (SCX) regulates the synthesis of ECM proteins in heart fibrosis. SCX expression was evaluated in lung fibroblasts and tissue derived from fibrotic disease patients and healthy controls. We also measured SCX in sera from 57 healthy controls, and 56 Idiopathic Pulmonary Fibrosis (IPF), 40 Hypersensitivity Pneumonitis (HP), and 100 Systemic Sclerosis (SSc) patients. We report high SCX expression in fibroblasts and tissue from IPF patients versus controls. High SCX-serum levels were observed in IPF (0.663 ± 0.559 ng/mL, p < 0.01) and SSc (0.611 ± 0.296 ng/mL, p < 0.001), versus controls (0.351 ± 0.207 ng/mL) and HP (0.323 ± 0.323 ng/mL). Serum levels of the SCX heterodimerization partner, TCF3, did not associate with fibrotic illness. IPF patients with severely affected respiratory capacities and late-stage SSc patients presenting anti-topoisomerase I antibodies and interstitial lung disease showed the highest SCX-serum levels. SCX gain-of-function induced the expression of alpha-smooth muscle actin (α-SMA/ACTA2) in fibroblasts when co-overexpressed with TCF3. As late and severe stages of the fibrotic processes correlated with high circulating SCX, we postulate it as a candidate biomarker of fibrosis and a potential therapeutic target.

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BACKGROUND: Adherence to disease-modifying therapies is determinant to attain maximal clinical benefit in multiple sclerosis (MS). RebiSmart® is an electronic auto-injector for subcutaneous delivery of interferon ß-1a (INF-ß1a) that monitors adherence by featuring a log of each drug administration for objective evaluation. The aim of this study was to assess long-term adherence to INF-ß1a by using the RebiSmart® device in Mexican patients with relapsing MS. METHODS: This is an observational multicenter study on patients with relapsing MS treated with INF-ß1a subcutaneously delivered by the RebiSmart® device. Adherence was computed as the number of injections received during the study period divided by the number of injections scheduled and expressed as percent. RESULTS: A total of 66 patients from 6 specialized MS centers were evaluated (45 females and 21 males, mean age 43.91±13.32 years). Mean adherence was 79.51±18% (median: 85.54%, range: 34.4-100%). During a median follow-up of 27.5 months (mean 33.36±29.39 months) the annualized relapse rate had a mean of 0.50±1.63. Mean initial EDSS was 1.90±1.52, and mean EDSS at the end of follow-up was 1.80±1.74. Compared with their counterparts, the mean number of relapses was significantly lower among patients with high (>80%) adherence (0.25±0.44 vs 0.67±92 relapses, respectively; P = 0.03). The proportion of relapse-free patients was 75.0% among patients with high adherence and 53.3% in low-compliant patients (P = 0.06). High adherence patients presented lower rates of EDSS worsening ≥1.0 at the end of treatment, as compared with low-compliant patients (11.1% vs 43.3%, respectively; P = 0.003). High schooling (>12 years) was the only predictor of a high adherence (OR: 2.97, 05% CI: 1.08-1.18; P = 0.03) and of being relapse-free during follow-up (OR: 3.22, 05% CI: 1.12-9.23; P = 0.03). CONCLUSION: Adherence to INF-ß1a using RebiSmart® in this Mexican cohort with MS was moderate, but associated with low relapse rate and influenced by high schooling.

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Resumen: La esclerosis múltiple es una de las principales enfermedades desmielinizantes del sistema nervioso central, que repercute no solo en lo económico, sino también en lo social. El Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) dispone de la mayor parte de los tratamientos que modifican la evolución de esta enfermedad y para optimizar su uso, un grupo de neurólogos de la institución se reunió para la realización de un documento sobre aspectos generales de diagnóstico y tratamiento denominado Consenso para el Diagnóstico y Tratamiento de la Esclerosis múltiple en pacientes del ISSSTE. El objetivo de este documento es dar recomendaciones de las diferentes alternativas terapéuticas contra la esclerosis múltiple.

Abstract: Multiple sclerosis is one of the main demyelinating diseases of the central nervous system, which impacts not only economically but also socially. The Mexican Institute of Security and Social Services of State Workers (ISSSTE) has most of the disease modifying treatments for this disease and to optimize its use, a group of neurologists from the institution met to make a document on general aspects of diagnosis and treatment called: Consensus for the diagnosis and treatment of multiple sclerosis in ISSSTE patients. The objective of this consensus is to give recommendations on the different therapeutic alternatives against multiple scle- rosis for adults and children.

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RESUMEN La carencia de una regulación sobre las plantas medicinales y el escaso control de calidad dado en Costa Rica ponen en riesgo la salud de la población. El objetivo del presente trabajo fue determinar la presencia de adulterantes en manzanilla (Matricaria chamomilla) y juanilama (Lippia alba) de venta a granel en mercados de San José, Heredia y Cartago, Costa Rica. Se recolectaron muestras de manzanilla y juanilama en diferentes puntos de venta dentro de los mercados de Cartago, Heredia y San José. Las muestras se analizaron en fresco y a través de los criterios establecidos por la OMS, para el control de calidad de productos herbarios, se estableció la cuantificación de materiales ajenos al producto comerciado como: insectos, mezclas de minerales del suelo, plástico, vidrio y moho. Los resultados fueron analizados con Excel 2010 y el programa estadístico IBM SPSS 22. En mercados de Heredia y San José se venden productos que no corresponden a la especie terapéutica ofrecida. La manzanilla es vendida principalmente en condiciones frescas, mientras que la juanilama varía su condición dependiendo del mercado. Hubo presencia de adulterantes, como insectos, tierra, plásticos y mohos, en las plantas de manzanilla y juanilama de venta en las provincias de Cartago, Heredia y San José.

SUMMARY The lack of regulation and quality control in Costa Rica on the medicinal plants has risks in public health. The aim of these work was to determinate presence of contaminants in chamomile (Matricaria chamomilla) and juanilama (Lippia alba) commercialized in the municipal markets in San José, Heredia and Cartago, Costa Rica. They were collected samples of chamomile and juanilama in different sale points within the Cartago, Heredia and San José markets. The samples were analyzed fresh and through the criteria established by WHO; for the quality control of herbal products, the quantification of materials foreign to the traded product was established: insects, mixtures of soil minerals, plastic, glass and mold. The results were analyzed with the statistical program SPSS 22. In some markets of Heredia and San José products do not correspond to the therapeutic species offered, and they were sold. Chamomile is sold mainly in fresh conditions, while the juanilama varies its condition depending on the market. There was presence of adulterants, such as insects, soil, plastics and molds, in plants chamomile and juanilama sold in the provinces of Cartago, Heredia and San José.

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Systemic sclerosis (SSc) is a complex rheumatologic autoimmune disease in which inflammation, fibrosis, and vasculopathy share several pathogenic pathways that lead to skin and internal organ damage. Recent findings regarding the participation and interaction of the innate and acquired immune system have led to a better understanding of the pathogenesis of the disease and to the identification of new therapeutic targets, many of which have been tested in preclinical and clinical trials with varying results. In this manuscript, we review the state of the art of the pathogenesis of this disease and discuss the main therapeutic targets related to each pathogenic mechanism that have been discovered so far.

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One of the most dreaded complications in Multiple Sclerosis (MS) patients treated with natalizumab is the appearance of the Progressive Multifocal Leukoencephalopathy (PML). A 54-year-old Mexican woman diagnosed eight years before with MS, received natalizumab for the last three years. The patient developed PLM that was confirmed by clinical, radiological, blood and CSF tests. Her treatment included methylprednisolone, plasmapheresis, immunoglobulin and mirtazapine. Risks, causes, treatments, preventive measures and opportune diagnosis for these patients are analyzed in this report.

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Disorder was induced in pristine highly oriented pyrolytic graphite (HOPG) by irradiation with H+ ions with energies of 0.4 MeV and 1 MeV, and doses of 1014 ions/cm2 and 1016 ions/cm2. Raman spectroscopy was used as the main technique to characterize different samples and gain new insights on the splitting of the D band into two components (D1 and D2), trying to correlate this feature of the vibrational spectrum with the impinging energy and dose. An increased I D2/I G ratio in comparison with I D1/I G was observed in the irradiated samples. This behavior indicates that the impinging energy mainly affects the D1 component, while the D2 component is strongly dominated by the dose. We expect a larger contribution of defects (originating from the rupture of C-C sp2 symmetry through the formation of C-H sp3 bonds) to the D2 component than to the D1 component. SQUID measurements of the irradiated samples showed an enhancement in the normalized remanence, as well as an increment in coercivity compared to pristine HOPG, consistent with H+-induced point-like defects as well as C-H bonds. AFM scanning after Raman and SQUID characterization showed a distribution of surface defects, which were ascribed to the burst of hydrogen blisters formed as a consequence of the irradiation process. The results presented in this work contribute to the current trend in nanotechnology in areas devoted to the control of properties by defect engineering in carbon-based materials.

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INTRODUCTION: Obstructive sleep apnea syndrome (OSA) occurs in 2-4% of adults, increasing by 2.5 times the risk of sudden death. OBJECTIVE: Establish the concordance of the clinical diagnostic and electrical diagnosis in an adult series that underwent polysomnography. MATERIALS AND METHODS: Patients with sleep disorders that underwent consecutively polysomnography recording. RESULTS: In this study, 51 subjects from 24 to 77 years old (54.1±12.12) were included in the study; 23 males and 28 females; 78.43% were overweight or obese; 35.29% were smokers; 31.37% alcohol consumers; 47.05% hypertensive; 21% diabetics; 35.29% with airway alterations; 29.41% with depression; 13.72% dyslipidaemic and 7.84% with ischemic heart disease. Only 22 of the subjects qualified for OSA and the concordance between the clinical diagnostic and polysomnographic recording was 54% (Ko=0.60, Ke 0.50, Ka=0.20) with a 0.55 sensibility, 0.66 specificity, PPV 0.54, NPV 0.65, PLR 1.2, RVN 0.69 and PPP 0.47. The neck circumference in OSA was 40.68±5 vs. 37.7±3.5 cm. (p<0.02) and BMI was 36.48±13.16 vs 29.37±6.58 (p<0.008); male/female proportion was 1.8:1 (p<0.01), BMI was higher in OSA (p<0.002). The Epworth Sleepiness Scale did not discriminate between OSA and other sleep alteration (p<0.29). DISCUSSION AND CONCLUSIONS: We observed a poor agreement between clinical diagnosis and polysomnography. The Epworth Sleepiness Scale did not discern between OSA and other sleep disorders and finally there was no association with a systemic process.

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For several decades, community interventions have promoted community development with strategies involving capacity building, advocacy, social change, and empowerment. Although community interventions intend to ameliorate social and economic inequalities, there is still a need to evaluate the outcomes of Participatory Action Research (PAR). PAR approaches have demonstrated to be a helpful tool to address and identify community issues and strengths and lead community members into action. The PAR approach described in this case study of "Juanacatlan Renace" (Juanacatlan Reborn)-the Concerns Report Method (CRM)-provided a process for the community to come together and identify main issues, organize, and take actions. The findings suggest multiple activities and outcomes in areas like environmental contamination, social services, and education. Participatory methodologies like the Concerns report Method provided opportunities to community members to become engaged in pursing issues and address their own needs. The implications for community psychology research and practice are discussed.

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For several decades, community interventions have promoted community development with strategies involving capacity building, advocacy, social change, and empowerment. Although community interventions intend to ameliorate social and economic inequalities, there is still a need to evaluate the outcomes of Participatory Action Research (PAR). PAR approaches have demonstrated to be a helpful tool for addressing and identifying community issues and strengths, while leading community members into action. The PAR approach described in this case study of Ciudad Renace (Town Reborn)-the Concerns Report Method (CRM)-provided a process for the community to come together and identify main issues, organize, and take actions. The findings suggest multiple activities and outcomes in areas like environmental contamination, social services, and education. Participatory methodologies like the Concerns report Method provided opportunities for community members to become engaged in pursing issues and addressing their own needs. The implications for community psychology research and practice are discussed.

Por varias décadas, las intervenciones comunitarias han promovido el desarrollo comunitario con estrategias que implican creación de capacidades, promoción, cambio social y empoderamiento. Aunque las intervenciones comunitarias tienen la intención de mejorar las desigualdades sociales y económicas, todavía hay una necesidad de evaluar los resultados de la Investigación Acción Participativa (IAP). Los enfoques IAP han demostrado ser una herramienta útil para el direccionamiento y la identificación de problemas y fortalezas de la comunidad, al mismo tiempo que alientan a los miembros de la comunidad a la acción. El enfoque IAP descrito en este estudio de caso sobre la Ciudad Renace con el Concerns Report Method (CRM) provee de un proceso que permite a la comunidad llegar a identificar en conjunto, sus principales problemas, organizarse y tomar acciones. Los hallazgos sugieren múltiples actividades y resultados en áreas como la contaminación ambiental, los servicios sociales y la educación. Las metodologias participativas como el CRM brindan oportunidades a los miembros de la comunidad para que se involucren en la búsqueda de sus propios problemas y hacer frente a sus necesidades. Se discuten las implicancias para la investigación y la práctica de la psicología comunitaria.

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Los niveles de lípidos elevados en sangre representan un importante factor de riesgo modificable en la aparición de enfermedad coronaria en pacientes con hipertensión arterial (3). Contar con fármacos que además de ejercer su acción antihipertensiva puedan también mejorar los niveles de los lípidos en sangre, deberían ser el norte de las nuevas investigaciones en esta área. En este estudio evaluamos la modificación del perfil lipídico en pacientes con hipertensión arterial en estadio I y II, tratados con valsartán, un antagonista de los receptores AT1 de la Angiotensina II. Se realizó un estudio prospectivo en 28 pacientes de ambos sexos, con edad promedio de 40,2 años y diagnóstico inicial de Hipertensión Arterial. Se incluyeron únicamente pacientes con Hipertensión Arterial en Estadio I y II. Se realizó perfil lipídico, al inicio y tres meses después de tratamiento con 80 mg/día de valsartán. El perfil lipídico inicial indicó que más del 50 por ciento de los pacientes tenían asociada una hiperlipidemia. Tres meses después del tratamiento se observó una reducción estadísticamente significativa de Colesterol Total (p=0,0037) y de LDL (p=0,0030) al igual que las relaciones Colesterol total/HDL y LDL/HDL (p=0,000298 y p=0,000894 respectivamente). Puede recomendarse el uso de valsartán como droga hipotensora en pacientes con diagnóstico inicial de Hipertensión Arterial Sistémica, sobre todo de aquellos que presenten asociados, niveles elevados de lípidos en sangre, especialmente el colesterol total, la LDL y las relaciones colesterol total/HDL y LDL/HDL, con lo que se reduciría el riesgo de enfermedad cardiovascular

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Antecedentes. La esclerosis múltiple se caracteriza por lesiones inflamatorias y desmielinizantes en la sustancia blanca del sistema nervioso central (SNC); el diagnóstico está fundamentado en criterios clínicos validados en poblaciones no latinas. Objetivo. Estudiar la correlación entre los criterios clínicos y la positividad del estudio de imagen por resonancia magnética (IRM) en pacientes con esclerosis múltiple. Material y métodos. Se realizó un estudio prospectivo, transversal y comparativo de 1995 a 1997. Se incluyeron pacientes enviados al servicio de neurología y que cumplieron con los criterios de Poser para esclerosis múltiple. A todos se les realizó historia clínica y neurológica, evaluación funcional (EDSS), punción lumbar con determinación de bandas oligoclonales, potenciales evocados e imagen por resonancia magnética de cráneo. Los pacientes se dividieron en dos grupos: a) esclerosis definida clínicamente y b) probable clínicamente; la positividad de la IRM se definió de acuerdo con los criterios de Paty & Fazekas. Resultados. Fueron 53 pacientes (36 mujeres y 17 hombres), con edad de 14 a 58 años. El 60 por ciento de ellos eran residentes del DF, la media en el tiempo de evolución de la enfermedad para el grupo A fue de 64 meses y la del B de 44. La IRM fue positiva en 33 enfermos y se relacionó con estadios funcionales más graves (p<0.001). Conclusiones. La mayor afección funcional fue el dato de mayor predictibilidad para la postividad de la IRM para esclerosis múltiple. El momento de realizar la IRM podría ser un factor que esté influyendo en la baja sensibilidad del estudio en nuestros enfermos

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